Peyronie’s disease

Peyronie’s treatments

Once you have been diagnosed with Peyronie’s disease by a urologist you may be offered treatment. It is possible that no treatment is needed if the condition does not affect sexual function, or if it is not painful. In around 5-15% of cases it will get better naturally, however the majority of men will need to consider different treatment options. The treatment that is right for you will depend on the severity of the curvature, what stage of the disease you are at, and how much it is affecting your life. It is strongly recommended to start your Peyronie’s treatment as soon as possible and ideally during the initial acute stage (as you can expect better results the sooner you start your treatment).

To get an idea of what a urologist can do, the interview on this pdf is very informative:  Prof Ralph Interview MyPeyronie’s

And for an overview of surgical options and when each one is appropriate, please watch this video by Prof Ralph.

A video by an American urologist about symptoms and possible treatments can be found on YouTube.

MEDICAL DEVICES

Traction devices and vacuum pumps can help stretch the penis, encouraging tissue growth and reducing curvature. These can be prescribed on the NHS or bought privately. Some anecdotal evidence on these is available at this website.

MEDICATION

Oral medication

Some oral medications are prescribed for Peyronie’s but there is no evidence to say that they are effective, although some men have reported improvements in the condition Potassium aminobenzoate (Potaba) can help to halt the disease and reduce plaque size. Pentoxifylline can improve blood flow Tamoxifen, usually used for breast cancer patients, can help to reduce inflammation. Sildenafil (Viagra) and Tadalafil (Cialis) can be used to stop progression of the disease and also help patients with Peyronie’s disease suffering from erectile dysfunction.

Topical medication

A range of creams and ointments has been tried, in the US especially Verapamil Gel and more recently a product called H-100. These are not (yet) available in Europe.

Intralesional medication

Collagenase will not be available in Europe, Asia or Australia  anymore from the beginning of 2020, due to a decision made by the American manufacturer to withdraw the product from these markets. This was not done because of safety or efficacy concerns.

Xiapex (an injection of an enzyme called collagenase clostridium histolyticum) is the first approved medical treatment for Peyronie’s disease. Collagenase works by dissolving the plaque that causes the penis to bend. A course of treatment with collagenase injections (up to eight) has been shown in clinical trials to reduce curvature of the penis by more than one-third on average. It may be an alternative to surgery for patients with moderate to severe Peyronie’s disease, i.e. a penis curvature of more than 30 degrees. It is only suitable for stable disease, so in a later stage.

Verapamil and interferon can be injected directly into the plaque on the penis (the thickened area) to dissolve the tissue and reduce curvature, or Verapamil can be applied as gel. These treatments are not commonly used in the UK.

A new development that needs more research but looks promising is H-100, a gel with nicardipine and superoxide dismutase in Emu oil, applied twice daily, which reduced pain and curvature in the patients who tried it. This is only available in the USA at the moment.

RADIOTHERAPY

Radiotherapy can have good effects on reducing pain but is not generally available. However there are two private clinics in London that offer it. Please find them listed here, both are in London.

EXTRACORPOREAL SHOCKWAVE THERAPY

Extracorporeal shockwave therapy (ESWT) involves the targeting of low frequency sound waves at the plaque (thickened area) on the penis, usually with an ultrasound scanner.

Guidance from the National Institute of Health and Care Excellence (NICE), the UK body that provides guidance and regulates treatments. states that there is not enough evidence to claim that extracorporeal ESWT is effective but it is safe.

PENIS SURGERY

Surgery has been proven to be the most effective treatment for Peyronie’s Disease, but it is not risk free and should be considered carefully by those with severe curvature only. Doctors recommend waiting at least 12 months before considering surgery, as in some men the condition improves without treatment. It is important to realise that surgery won’t be able to change the penis back to how it looked and felt before Peyronie’s disease but it can straighten out curvature.

Surgery options:

  • Plication or Tunical shortening – this is suitable for those with a curvature of less than 60 degrees and involves stitching closer together a section of the longer part of the penis cancelling out the curve. The effect tends to be that the penis is a shorter than it was before.
  • (Skin) grafting or Tunical lengthening – removing or cutting away the plaque and grafting normal skin or other types of tissue to straighten the penis and fill in the space left by removing the plaque. This is often used where the curve in the penis is quite severe usually over 60 degrees but is not advised for men who have had previous problems with erectile function.
  • Prosthetic techniques – implanting a device to straighten the penis. This process is most likely to be used for men who complete erectile dysfunction and is a non-reversible procedure.

An explanation of when is procedure is suitable can be heard in this video

For a list of Urologic Surgeons who have a special interest and knwoledge of  Peyronie’s Disease, visit our doctors page .

COUNSELLING

Peyronie’s disease does not only affect the body, it does also affect the mind. It is important not to overlook the emotional side of the disease. It is estimated that around half of men with Peyronie’s disease experience depression. If you feel depressed speak to your GP about counselling. You can also contact Relate if Peyronie’s disease has affected your relationship with your partner.